PRE-SURGERY BLOOD CELL RATIOS AND SURVIVAL IN PATIENTS WITH MALIGNANT GLIOMAS

Malignant diffuse gliomas (MG) of the brain (WHO grade 3-4) are highly aggressive primary tumors of central nervous system (CNS), spreading rapidly by infiltrating healthy brain tissue. In the majority of cases, tumor relapse occurs. The prognostic significance of pre-surgery factors, such as inflammatory markers, particularly, the peripheral blood counts in patients with MG is discussed and remains controversial. The aim of this study was to assess the relationship between the blood cell ratios and overall survival (OS) and relapse-free survival (RFS) in MG patients.

The data on 59 MG patients were analyzed: 41 cases of primary (newly diagnosed) MG (astrocytoma (A-III, WHO grade 3, n = 8) and glioblastoma (GB, WHO grade 4, n = 33)) and 18 cases of recurrent MG (recurrent A-III (WHO grade 3, n = 7) and recurrent GB (WHO grade 4, n = 11)). Blood cell counts (peripheral blood leukocytes (PBL), platelets (Pt), neutrophils (Neu), lymphocytes (Ly), monocytes (Mo)) and NLR (Neu/Ly ratio), PLR (Pt/Ly ratio), MLR (Mo/Ly ratio), and systemic immune-inflammation index (SII)) in the preoperative period (prior to re-resection in cases of recurrent MG) were evaluated. The Kaplan - Meier and Cox regression analyses of OS/RFS were performed. The potential association between the blood counts and ratios PLR (≤146 vs. >146), NLR (≤4 vs. >4), MLR (≤0.27 vs. >0.27), SII (≤906 vs. >906), as well as sex (female vs. male) and age (≤60 vs. >61) with OS and RFS were analyzed.

PBL and Neu counts, as well as NLR and SII indices, in patients with primary and recurrent GB in the pre-operative period significantly exceeded the reference values (p < 0.02). PBL, Neu, and SII significantly correlated with tumor grade. In patients with primary A-III and GB, longer OS tended to be associated with high PLR, NLR, MLR, and SII values, while in patients with recurrent GB, longer OS tended to be associated with low values of these ratios. Patients with recurrent A-III and GB showed a significant association between low pre-surgery NLR, SII and better RFS while patients with recurrent GB - significant association between low pre-surgery MLR and better RFS. Significant association between OS and sex of patients with both primary and recurrent GB was shown.

The results obtained suggest the possible prognostic significance of PLR, NLR, MLR, and SII values in the treatment outcomes of MG patients.